Making decisions in mental healthcare : a phenomenological study

Wharne, Simon James (2014). Making decisions in mental healthcare : a phenomenological study. PhD thesis The Open University.

DOI: https://doi.org/10.21954/ou.ro.0000d5b6

Abstract

People who are involved within the decision-making processes of mental healthcare understand and respond to distress in differing ways with important consequences for clinical practice. Within different knowledge systems, rational decision-making is thought to be impeded by biological, psychological or social constraints, implying different rights and responsibilities. Mental health practitioners seek to enable rational decision-making which improves lives. But some people resist and/or fail to act in their own interests. This study asks how mental health service users are involved in decisions; how do their workers understand this and what does this mean for policy and practice. The use of an innovative research methodology in this field of study is evaluated. Semi-structured interviews were conducted with sixteen participants who had varying kinds of involvement m mental healthcare; service users, workers and family carers. Audio recordings of interviews were transcribed and analysed using an existentially informed hermeneutic phenomenological approach. All participants described a feeling of being under scrutiny, struggling to maintain personal coherence when explaining their decisions. Their reasonableness or irrationality switched about alarmingly when various medical, psychological or social means of understanding were promoted. 'Being in relation to others ' generated containment which could feel supportive, or oppressive. Some participants felt that control was exercised over them, rather than their mental illness. The expression of freewill could be interpreted negatively as a lack of insight, or for workers, with a lack of professionalism. In this thesis I argue that rather than relying on rational healthcare systems and contested causal theories, the embodied, interpersonal and human qualities of decisions should be recognised. Theoretical models are needed, within which notions of freewill and autonomy are understood and promoted. I highlight the value of phenomenological methods in understanding the complex, often contested, understandings of all parties involved in decision-making in mental healthcare.

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